Deterioration of chest wall depression causing congestive hepatopathy after an open thoracostomy window in a patient wit
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CASE REPORT
Deterioration of chest wall depression causing congestive hepatopathy after an open thoracostomy window in a patient with pectus excavatum and tuberculosis empyema Jung Wook Han1 · Jae Jun Kim1 · Yoon‑Hyo Lee2 · Jae‑Myeong Lee1 Received: 2 July 2019 / Accepted: 15 October 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract A 27-year-old man with severe pectus excavatum, dextrocardia and spinal scoliosis underwent thoracoscopic pleural decortication due to failure of 1-month medical treatment for tuberculous empyema. One month after the pleural decortication, he again underwent open thoracostomy window for repetitive pleuro-cutaneous fistula with tuberculosis empyema. He was subsequently referred to our clinic for progressive dyspnea and bilateral leg edema 4 months after the open thoracostomy window. Evaluations revealed deterioration of the chest wall depression and further compression of the inferior vena cava, which were considered an aggravation of the pectus excavatum after the open thoracostomy window. Herein, we present an extremely rare case of deterioration of chest wall depression causing congestive hepatopathy after an open thoracostomy window in a patient with pectus excavatum and tuberculosis empyema. Keywords Pectus excavatum · Open thoracostomy window · Congestive hepatopathy
Introduction An open thoracostomy window is performed to control empyema and complications after pulmonary resections [1–3]. Because the open thoracostomy window constricts the chest wall cavity, the degree of pectus excavatum is aggravated and results in further compression of internal organs. Herein, we present an extremely rare case of deterioration of chest wall depression causing congestive hepatopathy after * Jae Jun Kim [email protected] Jung Wook Han [email protected] Yoon‑Hyo Lee [email protected] Jae‑Myeong Lee [email protected] 1
Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Geumo‑dong, Uijeongbu, Gyeonggi‑do 480‑717, Republic of Korea
Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2
an open thoracostomy window in a patient with pectus excavatum and tuberculosis empyema.
Case presentation A 27-year-old man was referred to our clinic for progressive dyspnea. He was normotensive (115/75 mmHg), tachycardic (134 beats/min), and tachypneic (34 breaths/min). A simple chest X-ray revealed a massive left pleural effusion, and a pleural drainage procedure was performed (Fig. 1A). Evaluations, including chest computed tomography (CT) and pleural fluid studies, were suggestive of tuberculosis empyema. The CT also demonstrated pectus excavatum (Fig. 1B). A 1-month course of medical treatment for tuberculosis empyema failed, a pleural decortication was performed. The patient was discharged without any complications on the 14th postoperative day. However, the empyema deteriorated, and a repetitive pleuro-cutaneou
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